DOL OFLC, Form ETA-790A Addendum B

OMB Approval: 1205-0466 Expiration Date: 07/31/2027 C.1. Additional Agricultural Business Information Ag Business 1 1. FEIN (from IRS) * 2. Legal Business Name * H-2A Agricultural Clearance Order Form ETA-790A Addendum B U.S. Department of Labor 3.

Total Workers * 4. Trade Name/Doing Business As (DBA), if applicable § 5. Previous DBA, if applicable § 6. Previous DBA, if applicable § 7.

Address 1 * 9. City * Ag Business 2 10. State * 11. Postal code * 12.

County * 8. Address 2 (suite/floor and number) § 1. FEIN (from IRS) * 2. Legal Business Name * 3.

Total Workers * 4. Trade Name/Doing Business As (DBA), if applicable § 5. Previous DBA, if applicable § 6. Previous DBA, if applicable § 7.

Address 1 * 9. City * Ag Business 3 10. State * 11. Postal code * 12.

County * 8. Address 2 (suite/floor and number) § 1. FEIN (from IRS) * 2. Legal Business Name * 3.

Total Workers * 4. Trade Name/Doing Business As (DBA), if applicable § 5. Previous DBA, if applicable § 6. Previous DBA, if applicable § 7.

Address 1 * 9. City * 10. State * 11. Postal code * 12.

County * 8. Address 2 (suite/floor and number) § Form ETA-790A Addendum B FOR DEPARTMENT OF LABOR USE ONLY Page B.1 of B.3 H-2A Case Number: ____________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________ OMB Approval: 1205-0466 Expiration Date: 07/31/2027 C.2. Additional Place of Employment Information 1. Legal Business Name * 2.

Place of Employment * a. Address Location * H-2A Agricultural Clearance Order Form ETA-790A Addendum B U.S. Department of Labor 3. Additional Place of Employment Information and Crop and Agricultural Activity * 4. Begin Date § 5. End Date § b. City * c. State* d. Postal Code * e. County * a. Address Location * b. City * c. State* d. Postal Code * e. County * a. Address Location * b. City * c. State* d. Postal Code * e. County * Form ETA-790A Addendum B FOR DEPARTMENT OF LABOR USE ONLY Page B.2 of B.3 H-2A Case Number: ____________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________ OMB Approval: 1205-0466 Expiration Date: 07/31/2027 D. Additional Housing Information H-2A Agricultural Clearance Order Form ETA-790A Addendum B U.S. Department of Labor 1.

Type of Housing * 2. Physical Location * 3. Additional Housing Information § 4. Total 5.

Total Units * Occupancy * 6. Inspection Entity * a. Address Location *  Employer-provided  Rental or public accommodations b. City * d. Postal Code * e. County * a. Address Location *  Employer-provided  Rental or public accommodations b. City * d. Postal Code * e. Postal Code * a. Address Location *  Employer-provided  Rental or public accommodations b. City * d. Postal Code * e. Postal Code * a. Address Location *  Employer-provided  Rental or public accommodations b. City * d. Postal Code * e. Postal Code * a. Address Location *  Employer-provided  Rental or public accommodations b. City * d. Postal Code * e. Postal Code * c. State * c. State * c. State * c. State * c. State *  Local authority  SWA  Other State authority  Federal authority  Other _______________  Local authority  SWA  Other State authority  Federal authority  Other _______________  Local authority  SWA  Other State authority  Federal authority  Other _______________  Local authority  SWA  Other State authority  Federal authority  Other _______________  Local authority  SWA  Other State authority  Federal authority  Other _______________ For Public Burden Statement, see the Instructions for Form ETA-790/790A. Form ETA-790A Addendum B FOR DEPARTMENT OF LABOR USE ONLY Page B.3 of B.3 H-2A Case Number: ____________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________